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Parent's First name
Parent's Last name
Which Group Are You Applying For
DBT Skills Groups
Teen Talks
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Email address
Telephone Number
How did you hear about us?
Teen's First Name
Teen's Age
13
14
15
16
17
18
19
What is the current biggest challenge your teen is facing?
What would you like your teen to accomplish in group?
What is the current biggest challenge you are facing as a parent?
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